Manoj Kumar Rohit

Hypocalcemia nutritional rickets: a curable cause of dilated cardiomyopathy.

Dilated cardiomyopathy is an important cause of heart failure in children. Often it requires transplantation, but on rare occasions it is curable by micronutrient supplementation. Hypocalcemic nutritional rickets was found to be a cause for dilated cardiomyopathy in a 15-month-old child. The patient responded to calcium and vitamin D supplementation promptly and left ventricular systolic function normalized after 3 months of treatment. Nutritional rickets must the considered as an important curable cause for dilated cardiomyopathy among children especially in regions where nutritional rickets is still common.

Variance in coronary venous anatomy: a critical determinant in optimal candidate selection for cardiac resynchronization therapy.

Knowledge of coronary sinus (CS) anatomy and its variations is one of the important factors determining the final position of left ventricle pacing lead during cardiac resynchronization therapy.

Risk factors for thromboembolism and pulmonary artery hypertension following splenectomy in children with hereditary spherocytosis.

The aim was to study risk‐factors for vascular thrombosis and incidence of pulmonary artery hypertension (PAH) in splenectomized children with hereditary spherocytosis (HS) at a single center.

Correlation of 64 row MDCT, echocardiography and cardiac catheterization angiography in assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease

OBJECTIVE To study the correlation of low-dose 64-row multi-detector computed tomography (MDCT) with echocardiography and cardiac catheterization angiography (CCA) in the assessment of pulmonary arterial anatomy in children with cyanotic congenital heart disease (CCHD). MATERIALS AND METHODS This prospective study included 105 children (74 males, 31 females) with CCHD, in the age group of 2 months to 20 years, who underwent 64-row MDCT examination (low-dose CT protocol), echocardiography and CCA for the assessment of pulmonary arteries, including visualization, presence of confluence, stenosis and collaterals. Statistical analysis was performed using the non-parametric statistical analysis test to evaluate the concordance or discordance between echocardiography, MDCT and CCA. RESULTS 64-row MDCT detected significantly more main and branch pulmonary arteries, patent pulmonary confluences, and more cases of pulmonary artery stenosis. CCA detected more major aorto-pulmonary collaterals than MDCT, whereas echocardiography failed to identify these major aorto-pulmonary collaterals. The effective CT radiation dose to patients less than 2 years of age was in the range of 0.7-2.5 mSv, where as the dose in patients more than 2 years of age ranged from that of 2.1 to 4.2 mSv, which is much less than the radiation dose reported in cardiac catheterization angiography. CONCLUSION In cases where cardiac MRI cannot be performed, or is not sufficiently informative, low-dose 64-row MDCT correlates well with CCA and can provide adequate information about pulmonary arterial anatomy in children with cyanotic congenital heart disease, and can replace invasive cardiac catheterization angiography with markedly reduced radiation dosage to the patient.

Percutaneous Transcatheter Device Closure of an Isolated Congenital LV Diverticulum: First Case Report

A congenital left ventricular diverticulum is a rare cardiac malformation. It is a developmental anomaly that occurs during embryogenesis. Presentations vary from asymptomatic patients to sudden death. To date, the treatment described has been surgical correction. The authors report the first transcatheter closure of an isolated congenital left ventricular diverticulum in a 12-year-old symptomatic girl.

Comparison of LVEF assessed by 2D echocardiography, gated blood pool SPECT, 99mTc tetrofosmin gated SPECT, and 18F-FDG gated PET with ERNV in patients with CAD and severe LV dysfunction.

IntroductionLeft ventricular ejection fraction (LVEF) is the single most important predictor of prognosis in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Equilibrium radionuclide ventriculography (ERNV) is considered the most reliable technique for assessing LVEF. Most of these patients undergo two dimensional (2D) echocardiography and myocardial viability study using gated myocardial perfusion imaging (MPI) or gated 18F-fluorodeoxyglucose (18F-FDG) PET. However, the accuracy of LVEF assessed by these methods is not clear. This study has been designed to assess the correlation and agreement between the LVEF measured by 2D echocardiography, gated blood pool single photon emission computed tomography (SPECT), 99mTc tetrofosmin gated SPECT, and 18F-FDG gated PET with ERNV in CAD patients with severe LV dysfunction. Patients and methodsPatients with CAD and severe LV dysfunction [ejection fraction (EF) <35 assessed by 2D echocardiography] were prospectively included in the study. These patients underwent ERNV along with gated blood pool SPECT, 99mTc tetrofosmin gated SPECT, and 18F-FDG gated PET as per the standard protocol for myocardial viability assessment and LVEF calculation. Spearman’s coefficient of correlation (r) was calculated for the different sets of values with significance level kept at a P-value less than 0.05. Bland–Altman plots were inspected to visually assess the between-agreement measurements from different methods. ResultsForty-one patients were prospectively included. LVEF calculated by various radionuclide methods showed good correlation with ERNV as follows: gated blood pool SPECT, r=0.92; MPI gated SPECT, r=0.85; and 18F-FDG gated PET, r=0.76. However, the correlation between 2D echocardiography and ERNV was poor (r=0.520). The Bland–Altman plot for LVEF measured by all radionuclide methods showed good agreement with ERNV. However, agreement between 2D echocardiography and ERNV is poor, as most of the values in this plot gave a negative difference for low EF and a positive difference for high EF. The mean difference between various techniques [2D echocardiography (a), gated blood pool SPECT (b), MPI gated SPECT (c), 18F-FDG gated PET (d)] and ERNV (e) was as follows: (a)−(e), 3.3; (b)−(e), 5; (c)−(e), 1.1; and (d)−(e), 2.9. The best possible correlation and agreement was found between MPI gated SPECT and ERNV. ConclusionThis study showed good correlation and agreement between MPI gated SPECT and 18F-FDG gated PET with ERNV for LVEF calculation in CAD patients with severe LV dysfunction. Thus, subjecting patients who undergo viability assessment by MPI gated SPECT or 18F-FDG gated PET to a separate procedure like ERNV for LVEF assessment may not be warranted. As the gated blood pool SPECT also showed good correlation and agreement with ERNV for LVEF assessment in CAD patients with severe LV dysfunction, with better characteristics than ERNV, it can be routinely used whenever accurate LVEF assessment is needed.

Aberrant right vertebral artery from descending thoracic aorta.

We present a case of an abnormal origin of right subclavian artery and right vertebral artery distal to the origin of left subclavian artery in a 2-year-old patient who presented with cyanotic congenital heart disease with single ventricle physiology. The anomalous origin of a right vertebral artery from the proximal descending thoracic aorta is very rare. We have described the cine-angiographic identification of its origin and course, its embryologic development, and its clinical relevance.

Recurrent ventricular tachycardia in a child with juvenile dermatomyositis - an unusual association.

Dear Editor, Juvenile dermatomyositis (JDM) is an inflammatory myopathy which can affect the heart. Conduction disturbances have been reported in JDM. We report a child with JDM who had recurrent ventricular tachycardia (VT). To the best of our knowledge, ours is the first such case reported in the literature. G, an 11-year-old boy, was diagnosed as having JDM. Electrocardiogram (ECG) showed only transient ventricular ectopics. Echocardiographic examination of the heart was also normal. He was started on oral prednisolone (2 mg/kg/day) and subcutaneous weekly methotrexate (10 mg/week) along with nasogastric tube feeds and a regular physiotherapy regimen and was subsequently discharged. Two days after discharge, he developed sudden onset respiratory distress along with sweating and palpitation. Physical examination revealed nasogastric tube displacement and clinical evidence of pneumonia. ECG done at this time showed VT, although the patient was hemodynamically stable. Echocardiographic examination of the child was normal, the ejection fraction being 70%. Stress myocardial perfusion study with thallium showed mild stress-induced reversible ischemic changes in the septum and the inferior wall and moderate stress-induced reversible ischemia in the anterior wall and the lateral wall at the level of induced stress. For VT, intravenous lignocaine infusion (up to a maximum of 50 lg/kg/min) was given with no response. Subsequently amiodarone infusion (0.5 mg/kg/min) was started and a normal sinus rhythm was achieved. The patient was put on a maintenance dose of amiodarone and discharged. His muscle weakness improved gradually during follow-up. Tube feeds were discontinued after 8 months. Methotrexate was continued and prednisolone was gradually tapered over 30 months. He did not have any cardiac compromise and follow-up ECG studies showed no evidence of ventricular ectopics or VT. Coronary arteriography was also normal and amiodarone was thus tapered over 27 months. The patient had a disease relapse/exacerbation 6 months after steroid discontinuation. Prenisolone was restarted. Repeat ECG during relapse showed ventricular ectopics. During 24-h Holter monitoring, he had intermittent episodes of ventricular ectopics (singlets, couplets, bigeminy and trigeminy) and non-sustained VT. Two episodes of sustained VT were also recorded, the longest being more than 2 min duration). No bradyarhythmias were noted. Prednisolone and oral amiodarone were started and a normal sinus rhythm was achieved. He showed gradual improvement in muscle power over the next 4 months and oral prednisolone was tapered. ECG and echocardiogram remained normal and amiodarone was stopped after 4 months. By this time, he had developed cutaneous calcinosis on both shins. He again presented after 1 year with another disease relapse. This time, he was hospitalized and put on pulse methyl prednisolone (30 mg/kg intravenously). ECG again showed ventricular bigeminy and intermittent VT. Amiodarone infusion followed by oral amiodarone and metoprolol were given. Subsequent ECGs showed normal sinus rhythm. During this relapse, he developed a leak in the second part of the duodenum with massive hematemesis and then succumbed to the condition. Juvenile dermatomyositis is a rare autoimmune disease which leads to a progressive symmetric weakness. Cardiac involvement has been increasingly recognized in the last few years in inflammatory myopathies, including JDM. Congestive heart failure, myocarditis, cardiomyopathy, coronary artery disease, vasospastic angina and arrhythmias have been recognized in association with JDM. ECG abnormalities are among the most common seen in 32.5–72% cases. These predominantly consist of conduction abnormalities such as A-V blocks, bundle branch block, high-grade heart

Right ventricular thickness as predictor of global myocardial performance in systemic sclerosis: A Doppler tissue imaging study

BACKGROUND Cardiopulmonary involvement in systemic sclerosis (SSc) is a poor prognostic factor, due to pulmonary hypertension and right ventricular dysfunction. We assessed the echocardiographic parameters of right ventricular (RV) function in SSc and correlated echocardiographic findings to clinical features of the disease. METHODS Thirty patients with SSc (cases) and 30 healthy, age-matched subjects (controls) were studied. Echocardiography, including tissue Doppler imaging, was used to evaluate cardiac function. RESULTS Pulmonary hypertension could be documented in only 5 cases by Doppler echo, using Bernoulli principle. RV diastolic function was significantly deranged in cases. RV systolic function and left ventricle (LV) diastolic function were also significantly deranged in the cases. RV thickness was increased in patients with SSc. There were no significant differences in the echocardiographic variables between diffuse and limited subtypes of SSc. Myocardial performance index (MPI) of both ventricles were increased in cases. We could demonstrate RV thickness as the single most important predictor of MPI of both ventricles with sensitivity of 82% and specificity of 72% for RV-MPI and 63% for LV-MPI. Diastolic function was not found to be affected by disease duration or Rodnan skin score. CONCLUSION Patients with SSc exhibit abnormal RV and LV diastolic functions as well as abnormal RV systolic function. RV wall thickness was found to be simple and the single best predictor of global myocardial performance. RV dysfunction may be a response to intermittent pulmonary arterial hypertension, lung parenchymal involvement, or secondary to LV diastolic dysfunction in SSc.

Speckle Noise Reduction in B-Mode Echocardiographic Images: A comparison

ABSTRACT This paper presents the despeckling applications of 48 filters for B-mode echocardiographic images. The filters are grouped into eight types, namely, local statistics, fuzzy, Fourier, multiscale, nonlinear iterative, total variation, nonlocal mean, and hybrid. The thrust areas of analyses are noise suppression, edge, and structure preservation evaluated in terms of image quality metrics, visual quality assessment, and clinical validation. The comparative analysis reveals that filters based on generalized likelihood ratio, local statistics (mean and variance), detail preserving anisotropic diffusion, fast bilateral, sparse representation based beta process factor analysis, and patch-based locally optimal Wiener and probabilistic nonlocal means stand out among the techniques being considered for comparison.